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What can you do about the latest clinical correspondence calamity?

Patient records – and the inability of the NHS and its appointed contractors to handle them correctly – once again hit the headlines this week. This time, rather than Capita being in the firing line it was NHS Shared Business Services (SBS), who was employed in the East Midlands, South West and north-east London to redirect mail for the health service.

It was meant to pass on documents that had either been incorrectly addressed or needed re-routing because the patient had moved to a new GP surgery. But between 2011 and 2016 a backlog of 709,000 pieces of correspondence piled up in a NHS SBS warehouse.

A report into the debacle by the National Audit Office found that:

As at 31 May 2017, the review of the backlog of correspondence has found 1,788 cases of potential harm to patients. NHS England and SBS have identified just under 709,000 items of unprocessed correspondence. One-third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. No case of actual harm has been identified yet.

NHS England estimates the cost of the incident will be at least £6.6 millionfor administration alone, and is still discussing with NHS SBS how these costs will be split.

Between 2008 and 2012 SBS entered into contracts with 26 Primary Care Trusts (PCTs) to provide primary care support services. Only 21 of these contracts explicitly included a service to redirect clinical and other correspondence which had been sent to the wrong GP or other clinical providers. None of the contracts contained Key Performance Indicators to measure how well SBS was delivering the service.

When NHS SBS took over the work of forwarding misdirected clinical correspondence from East Midlands PCTs in 2011, it inherited a backlog of unprocessed clinical correspondence. It found 8,146 items of unprocessed correspondence.

Over the next four years the backlog continued to grow, from 8,146 items in 2011 to 205,000 items in January 2014, 351,000 items in June 2015, and 435,000 items by the time SBS reported the incident to NHS England in March 2016.

Managers at SBS had been aware of the clinical risk to patients since January 2014 but did not develop a plan to deal with the backlog. SBS informed NHS England and the Department about the problem in March 2016. The SBS chief executive reported that staff considered this work to be ‘just filing’, although he stressed that this did not excuse the backlog.

The Department decided in March 2016 not to alert Parliament or the public about the incident initially as it considered it too early to understand the full extent of harm that may have been caused to patients.

NHS England were dissatisfied with NHS SBS’s co-operation in understanding the facts and causes of the incident.NHS England considered that SBS was being obstructive and unhelpful in providing the access it sought. It was September 2016, six months after the incident was disclosed to NHS England, before full agreement was reached for NHS England’s internal auditor to access the material required for its review.

In light of the well-publicised Capita problems – which are still very much ongoing if the comments on the Practice Index forum are anything to go by – the question remains as to why NHS England will learn from its mistakes and whether heads will roll. We doubt the answer to either question will be yes, which leaves GP practices on the frontline having to deal with the mess.

Dealing with it

So what can you as a practice manager to do to ensure the NHS mess doesn’t negatively impact on you? Here are a few suggestions:

Set the record straight: Consider publishing a statement on your website and/or printing out some flyers for people who are interested. It needn’t be long or detailed – and something along the lines of the following could work:

You may have read in the media this week that hundreds of thousands of pieces of clinical correspondence have not been passed on to the relevant GP practice, affecting approximately 2,000 patients.

This issue has been created by the failings of a third-party contractor, NHS Shared Business Services, contracted by the NHS, that has failed practices and patients.

As a practice we are working with the relevant authorities to ensure none of our patients are impacted by the problems – and it has been confirmed by the National Audit Office that no patients have been put at risk.

Respond to requests: As the NAO report says, one-third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. Please try to sort out any outstanding requests as soon as possible.

Speak to your local MP: Now is the time to lobby your local MP to raise the issue in parliament. Time-permitting, keep pestering your MP – the more practices that do this, the more pressure will be put on NHS England and SBS to sort out the mess.

Stay on top of the news: Keep an eye on the news for updates on the story – and keep your patients up-to-date if necessary.

Have you been affected by this latest correspondence crisis? Let us know by commenting below or in the Practice Index Forum thread here.